8. Amount 01 02 03 04 05 06 07 9. Total $ 10. Justification: Asset/Informant Ale No. Symbol No. Payment/Code Name Period Covered One Time Non-symbol Source Payment: True Name: DOB: / / SSAN: Date of Waiver: / / to 11. Payment for reimbursable expense - forfeiture or drug related?

,... • • r .., --•• • • , ••••V .14 9. Total $ 10. Justification: Assetanformant File No. Symbol No. Payment/Code Name Period Covered to One Time Non-symbol Source Payment: True Name: DOB: / / SSAN: _.. --- Date of Waiver: / / 11. Payment for reimbursable expense - forfeiture or drug rela

. Amount 01 02 03 04 05 06 07 9. Total $ 10. Justification: Asset/Informant File No. Symbol No. PaymenVCode Name Period Covered to One Time Non-symbol Source Payment: True Name: DOB- / / SSAN: Date of Waiver: / i 11 Payment for reimbursable expense - forfeiture or drug related? Yes

rif; font-size: l0pt;">Arriving=td style="font-family: arial, sans-serif; font-size: l0pt;">03:00 PM=/tr> Departure Terminal Terminal 1 Estimated Time Non-stop Seats 23A Confirmed <=tbody> Friday 19 Dec 14 Flight Information Date19 Dec 2014 Airline American Airlines </=r> Airline Record Locato

. Amount • 01 02 04 05 06 07 9. Total $ 10. Justification: Asset/Informant File No. Symbol No. Payment/Code Name Period Covered to One Time Non-symbol Source Payment: True Name: DOB: / / SSAN: Date of Waiver: / / 11. Payment for reimbursable expense - forfeiture or drug related? Yes

on' i t t l le kii vitt I l( % (11(1? lire. el I I I lee teli.k Asset/Informant File No. Symbol No. Payment/Code Name Period Covered to One Time Non-symbol Source Payment: True Name: b08: / Date of Waiver • :. _t_/ .. . . 11. Payment for r • &Lig related? _Yes 12. Requested by 13. Tele